rhunter007@att.net
Contributor
Can CPT 87811 be used to bill OTC COVID test or is it restricted to being performed in a laboratory?
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Wiki OTC COVID Test
- Thread starter rhunter007@att.net
- Start date
CBLENNIE
Expert
Actually, there is a specific HCPCS code for OTC COVID-19 tests K1034.
rhunter007@att.net
Contributor
Yes, but K1034 ended on 5/11/23
CBLENNIE
Expert
I don't show the code is termed in Encoder Pro, what ended on 05/11/23 is the PHE and Medicare's coverage of the OTC tests. The long description of the code in Encoder Pro states the following:
If you are looking to bill Medicare you should not be as they no longer cover the OTC tests and you should not trying to get reimbursement from Medicare for OTCs with any CPT or HCPCS codes. Some MA plans stopped covering the OTC tests when Medicare did at the end of the PHE but some may still cover them. Some commercial payers may also still cover these OTC kits.
As for CPT 87811, this is for the performance of the COVID test not the provision of the OTC test kit. It should only be billed by providers who are actually administering the test.
For self-administered tests, CMS has created a code that may be reported to identify and cover over the counter (OTC) COVID-19 tests at no cost, including deductible and copays, for Medicare Part B and Medicare Advantage (MA) beneficiaries. Eligible beneficiaries can receive up to eight tests per calendar month from an eligible provider until the Public Health Emergency (PHE) ends. This code may be reported for single-test and multiple-test packages. One test equals one unit. Claims must be submitted by the provider, not the patient. All payer types, including Medicaid and private insurance, may report K1034.
If you are looking to bill Medicare you should not be as they no longer cover the OTC tests and you should not trying to get reimbursement from Medicare for OTCs with any CPT or HCPCS codes. Some MA plans stopped covering the OTC tests when Medicare did at the end of the PHE but some may still cover them. Some commercial payers may also still cover these OTC kits.
As for CPT 87811, this is for the performance of the COVID test not the provision of the OTC test kit. It should only be billed by providers who are actually administering the test.
rhunter007@att.net
Contributor
Thank you CBLENNIE for your input. Not billing Medicare an Medicaid for OTC since 5/11/23. However, California was extended to Nov. 11, 2023. Found 87811, has the same methodology at OTC test kits. After more review, found it is intended for performance in a laboratory or providers office. We will not use 87811 for billing OTC. Just looking for some input, thank you.